title: Shared decision making after MacIntyre.
abstract: This paper explores the practical consequences that Enlightenment ideals had on morality as it applies to clinical practice, using Alisdair MacIntyre's conceptualization and critique of the Enlightenment as its reference point. Taking the perspective of a practicing clinician, I critically examine the historical origins of ideas that made shared decision making (SDM) a necessary and ideal model of clinician-patient relationship. I then build on MacIntyre's critique of Enlightenment thought and examine its implications for conceptions of shared decision-making that use an Enlightenment justification, as well as examining contemporary threats to SDM that the Enlightenment made possible. I conclude by offering an alternative framing of SDM that fits with the clinician's duty to act on behalf of and along with patients but that avoids the tenuous Enlightenment assumptions that MacIntyre's work so vocally critiques.
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. tilburt.jon@mayo.edu
authors.forename: Jon
authors.initials: J
authors.lastname: Tilburt
mesh_terms: D003657:Decision Making / Q000941:ethics*; D006801:Humans; D009014:Morals; D010358:Patient Participation; D028701:Patient Rights / Q000941:ethics; D010686:Philosophy, Medical; D010817:Physician-Patient Relations / Q000941:ethics